I’m done 3 of my 4 overnight call shifts for inpatient pediatrics as of 7:30 this morning, and in my slightly deranged, sleep-deprived mind, I started to categorize the parents I’d seen in hospital so far. Don’t ask me why. Stuff happens to your brain on call.

And it’s true what the ever-omniscent “they” say – on pediatrics, you treat the kid and the family. Especially when they’re young, they just go together. And while the kids often need some reassurance about what you’re going to stick in their ear next, it’s the parents that really need the good talking-to.

So let me introduce the 5 parents you’re sure to meet:

1. The Acclimatized

These are often the easiest parents to deal with – usually their child has something congenital or chronic, something they’re well-versed in and well-read about. Even if their kid is quite sick, they keep their heads and can rationally answer all your involved questions because… well, they’ve been here already. It’s sad to see them so used to the system, but at the same time it’s a blessing to not have to explain what Hurler syndrome is at 3:00am.

However, because they’ve been so over-exposed to the medical system, they have the potential to be extra judgemental of learners (and probably for good reason), so try to stay humble and accept what they’re telling you, rather than straight-up challenging them with your own ideas.

Tips: Defer to them! Chances are, they’ve done more reading about their child’s condition than you. Plus they know their child’s signals and expressions, you may not.

2. The Overly Cautious

I didn’t want to call them “paranoid” – I’ve seen too many weird things on pedes to call anything outside the realm of possibility. But they are excessively worried about benign symptoms despite your best efforts to allay their fears. Their kids are often previously healthy and so they’re extra sensitive to changes, whether it be sleeping 1 hour more every day or having 1 less wet diaper. They can be super defensive if you push too hard in the “They’re-Well-Just-Relax” direction and then are more likely to blow the symptoms even more out of proportion.

Keep in mind that the kids are also sensitive, too – they’re amazing stress-detectors, so keeping the parents calm is key to being able to talk with the patient.

Tips: Sometimes a basic workup and a lot of reassurance is all they need. Address each concern specifically and allow them time to talk – the more unanswered questions they have, the higher the anxiety.

3. The Panicked

These parents are highly anxious, too, but unlike your Overly Cautious folks, there’s a perfectly good reason for their distress. In this case, it has less to do with the parents and more to do with the child – these kids really are quite sick, and usually sick very suddenly. They may have a bad infection, seizures, multi-system trauma… regardless, you’re going to be tempted to get into Medical Mode and focus all your attention on the child. While this is absolutely a good idea initially, keep those parents at the back of your mind. They’re the ones watching over your shoulder as you give their seizing child Ativan or their apneic child oxygen.

These are truly terrified, sleep-deprived people that occasionally dissolve right there in the exam room. They’re not thinking clearly and they’re certainly not getting every word you say. The most important thing is to be kind and gentle. Tell the truth, but as with as much compassion as you can squeeze into your words.

Tips: Take the parents aside, somewhere quiet, and give them the absolute basics of what’s going on. If they want to know more, that’s awesome, but know that you’ll probably have to tell them again later. Be empathetic.

4. The Nonchalant

I don’t mean to use completely obvious gender roles here, but I see this a lot in dads. It’s not so important whether the child is very sick or not, these dads just don’t appear to care much. They sit in their chairs , leaning back, watching the scene. If you ask anything of them, they might defer to their partner or give a non-committal answer. It can be frustrating, to say the least, but do not be fooled. These guys may be dealing with their stress by stepping away from it – it’s not that they don’t care, it’s that they’d rather not show you.

On the up side, having someone so calm in the room can be extremely helpful – if the other parent is an Overly Cautious type, they may help deflate the excess worry and dampen down the reported symptom severity. Gives you a couple of viewpoints, anyway.

Tips: It’s not worth being passive-aggressive about their behaviour; they’ll probably retreat further in a huff. Be sure to include them, but don’t judge them if they don’t actively contribute to the conversation.

5. The Aggressive

As somebody who absolutely detests confrontation, I feel most uncomfortable with these. Kind of the opposite of the Nonchalant types, these parents take their anxiety and, rather than keeping it hidden, make it known to anyone and everyone in the vicinity. Usually loudly. Again, they can be frustrating, but know that it’s part of their coping mechanism. They feel helpless and are desperately searching for a sense of control, and the more helpless they feel the more anxious they become until the tension becomes so great that they lash out or explode.

These parents are hurting. Badly. And their kids, those remarkable little kids, are receptive to that. In fact, they may try to become the therapists – they want their parents to be happy, so they may take on the parenting role, trying to soothe them. I always feel uneasy when this happens; these kids should be looked after by their parents, not the other way around. So I try to focus more of my attention on addressing the parents’ fears and giving them some peace of mind, even if I can’t give them control over their child’s illness.

Tips: Hold your ground. They’re not angry about something you’ve done or said, they’re just venting. Hear them and give their emotions some time to burn out before having any involved discussions.

This was an interesting exercise for me, hope it’s been useful for you too! As always, if you’ve got any ideas for the blog, requests, guests posts, etc, leave a comment below!

3 responses to “5 parents you’ll meet in pedes”

As a nurse, I can totally relate! I had a set of first-time parents get anxious once when their new baby girl was choking on a bit of mucous. Fortunately they were really nice about it, and all they asked was for me to help her and could I make sure that the doctor saw her that day – which I did. I could see they were worried, but they didn’t completely panic and they didn’t demand anything – just asked nicely. The ones I really dislike are the aggressive parents – and they don’t just show up as parents either! Once when I was still in rural nursing, we had a lady come in with severe hypertension. She was treated in the ER and wasn’t showing any signs of a stroke or heart attack, so the plan was to keep her overnight, monitor her vitals, and do some labs in the morning. I guess when she was still in ER, her husband was really pushing for her to be sent to “the city” (Edmonton). Even when she got admitted, he told us, “If she gets any worse tonight she WILL be sent to the city.” I think the problem is that people have seen one too many episodes of ER or House – they get what I like to call the “magic wand philosophy” (i.e. they think you just pull your magic wand out of your pocket and fix people). I totally agree that you need to treat the parents and not just the kid. I’m currently taking students for a maternity clinical, and I’m teaching them about the importance of watching parents’ interaction with their baby. You can really pick up a lot about how a parent will handle their child based on the interaction – something I’m sure you’ve noticed in Peds too.

Total geek + family med resident = so much win.

Disclaimer: I am a 1st year resident. Officially I now know some stuff. However, this blog is for your entertainment (including, but not limited to, giggles, snorts of laughter, eye-rolling, fist pumping, and shouting at your computer screen) and is not a good substitute for a visit to your family doctor's office.

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